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Outcome and determinants of mortality in 269 patients with combination anti‐tuberculosis drug‐induced liver injury
Author(s) -
Devarbhavi Harshad,
Singh Rajvir,
Patil Mallikarjun,
Sheth Keyur,
Adarsh Channagiri Krishnamurthy,
Balaraju Girisha
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2012.07279.x
Subject(s) - medicine , jaundice , gastroenterology , ascites , liver disease , creatinine , mortality rate , tuberculosis , encephalopathy , surgery , pathology
Background and Aim Worldwide anti‐tuberculosis ( TB ) drug‐induced liver disease ( DILI ) is an important cause of hepatotoxicity, and drug‐induced acute liver failure ( ALF ). Reported series on anti‐ TB DILI are limited by a mix of cases with mild transaminase elevation or adaptation. Our aim was to analyze the clinical features, laboratory characteristics, outcome, and determine predictors of 90‐day mortality. Methods Single center analysis of consecutive cases of anti‐ TB DILI following combination anti‐ TB drugs exposure from 1997–2011. Results Of the 269 patients, 191 (71%) experienced jaundice and 69 (25.7%) accounted for ALF . The mean age and treatment duration was 41.3 years and 1.9 months, respectively; males constituted 55.7%. DILI occurred throughout the course of treatment; three‐quarters occurred within the first 2 months. HIV infection was present in 21 (7.8%). The 90‐day mortality was 22.7%. DILI accompanied by jaundice ( n = 191), encephalopathy ( n = 69) or ascites ( n = 69) resulted in mortality in 30%, 69.6% and 50.7%, respectively ( P < 0.001). Age, gender, transaminase levels, HIV or hepatitis B surface antigen ( HBsAg) status did not influence survival. Treatment duration, encephalopathy, ascites, bilirubin, serum albumin, international normalized ratio ( INR) , serum creatinine and leukocyte count were associated with mortality ( P < 0.001). Multivariate logistic regression model for mortality, incorporating encephalopathy, albumin, bilirubin, INR , and creatinine yielded a C ‐statistic of 97%. Conclusions Anti‐ TB DILI occurs throughout treatment duration progressing to ALF in a quarter of patients. The overall mortality is 22.7%, which is higher when accompanied by jaundice, ascites or encephalopathy. An anti‐ TB DILI model, incorporating bilirubin, INR , encephalopathy, serum creatinine and albumin predicted mortality with C ‐statistic of 97%.